Lobo M.D.,Queen Mary, University of London |
Sobotka P.A.,ROX Medical |
Sobotka P.A.,Ohio State University |
Stanton A.,Royal College of Surgeons in Ireland |
And 16 more authors.
The Lancet | Year: 2015
Background: Hypertension contributes to cardiovascular morbidity and mortality. We assessed the safety and efficacy of a central iliac arteriovenous anastomosis to alter the mechanical arterial properties and reduce blood pressure in patients with uncontrolled hypertension. Methods: We enrolled patients in this open-label, multicentre, prospective, randomised, controlled trial between October, 2012, and April, 2014. Eligible patients had baseline office systolic blood pressure of 140 mm Hg or higher and average daytime ambulatory blood pressure of 135 mm Hg or higher systolic and 85 mm Hg or higher diastolic despite antihypertensive treatment. Patients were randomly allocated in a 1:1 ratio to undergo implantation of an arteriovenous coupler device plus current pharmaceutical treatment or to maintain current treatment alone (control). The primary endpoint was mean change from baseline in office and 24 h ambulatory systolic blood pressure at 6 months. Analysis was by modified intention to treat (all patients remaining in follow-up at 6 months). This trial is registered with ClinicalTrials.gov, number NCT01642498. Findings: 83 (43%) of 195 patients screened were assigned arteriovenous coupler therapy (n=44) or normal care (n=39). Mean office systolic blood pressure reduced by 26.9 (SD 23.9) mm Hg in the arteriovenous coupler group (p<0.0001) and by 3.7 (21.2) mm Hg in the control group (p=0.31). Mean systolic 24 h ambulatory blood pressure reduced by 13.5 (18.8) mm Hg (p<0.0001) in arteriovenous coupler recipients and by 0.5 (15.8) mm Hg (p=0.86) in controls. Implantation of the arteriovenous coupler was associated with late ipsilateral venous stenosis in 12 (29%) of 42 patients and was treatable with venoplasty or stenting. Interpretation: Arteriovenous anastomosis was associated with significantly reduced blood pressure and hypertensive complications. This approach might be a useful adjunctive therapy for patients with uncontrolled hypertension.
Horn E.-P.,Klinik fur Anasthesiologie |
Torossian A.,Universitatsklinikum Giessen und Marburg GmbH
Anasthesiologie Intensivmedizin Notfallmedizin Schmerztherapie | Year: 2010
Inadvertent perioperative hypothermia impairs postoperative outcome in surgical patients due to ischemic myocardial events, wound infections and coagulation disorders. Body core temperature should be assessed 12h preoperatively and continuously during surgery. To prevent hypothermia patients and nursing clinical staff should be teached and trained. Preoperatively surgical patients should always be prewarmed by using convective warming devices and active warming should be continued in surgeries longer than 1 hour. Warming of IV fluids is effective if infusion rates are above 1l/h. Core temperature should be measured in the recovery room and active warming should be started when patients are hypothermic or if they feel cold. © Georg Thieme Verlag KG Stuttgart New York.
Kraus R.,Universitatsklinikum Giessen und Marburg GmbH |
Wessel L.,Universitatsmedizin Mannheim
Deutsches Arzteblatt | Year: 2010
Background: The treatment of fractures in children and adolescents must be based on an adequate knowledge of the physiology of the growing skeleton. Treatment failures usually do not result from technical deficiencies, but rather from a misunderstanding of the special considerations applying to the treatment of fractures in this age group. Methods: We selectively reviewed recent publications on the main types of long bone fracture occurring in the period of skeletal development. Results: Alleviating pain is the first step in fracture management, and due attention must be paid to any evidence of child abuse. The goals of treatment are to bring about healing of the fracture and to preserve the function of the wounded limb. The growth that has yet to take place over the remaining period of skeletal development also has to be considered. Predicting the growth pattern of fractured bones is a basic task of the pediatric traumatologist. During the period of skeletal development, conservative and surgical treatments are used in complementary fashion. Particular expertise is needed to deal with fractures around the elbow, especially supracondylar humeral fractures, displaced fractures of the radial condyle of the humerus, radial neck fractures, and radial head dislocations (Monteggia lesions). These problems account for a large fraction of the avoidable cases of faulty fracture healing leading to functional impairment in children and adolescents. Conclusion: The main requirements for the proper treatment of fractures in children and adolescents are the immediate alleviation of pain and the provision of effective treatment (either in the hospital or on an outpatient basis) to ensure the best possible outcome, while the associated costs and effort is kept to a minimum. Further important goals are a rapid recovery of mobility and the avoidance of late complications, such as restriction of the range of motion or growth disorders of the fractured bone. To achieve these goals, the treating physician should have the necessary expertise in all of the applicable conservative and surgical treatment methods and should be able to apply them for the proper indications.
Van Dijk K.,Netherlands Institute for Innovative Ocular Surgery |
Droutsas K.,Netherlands Institute for Innovative Ocular Surgery |
Droutsas K.,Universitatsklinikum Giessen und Marburg GmbH |
Hou J.,Netherlands Institute for Innovative Ocular Surgery |
And 3 more authors.
American Journal of Ophthalmology | Year: 2014
Purpose To evaluate corneal higher-order aberrations (HOAs) and backscattered light before and after Descemet membrane endothelial keratoplasty (DMEK) and their correlation with visual outcome. Design Retrospective study. Methods In a total of 118 consecutive eyes of 118 patients who underwent uneventful DMEK for Fuchs endothelial dystrophy at a tertiary referral center, best spectacle-corrected visual acuity (BSCVA), corneal HOAs, and backscattered light were evaluated preoperatively and at 6 months postoperatively. Outcome data were compared to an age-matched control group with uncomplicated eyes (n = 27). Results Compared to the control group, Fuchs endothelial dystrophy eyes, before as well as 6 months after DMEK, showed higher values of anterior and posterior HOAs and backscattered light (P <.033). Postoperative anterior HOAs and backscattered light (0-2 mm) were associated with lower 6-month BSCVA (positively related with logMAR BSCVA) (P ≤.020). Anterior corneal HOAs did not change from preoperative to 6 months after DMEK (P =.649), while total posterior HOAs (RMS third to sixth Zernike order) and haze decreased (P <.001). Conclusions Anterior and posterior corneal HOAs, as well as backscattered light from the cornea, were elevated in eyes suffering from Fuchs endothelial dystrophy and remained higher throughout 6 months after DMEK. If present, anterior surface irregularities and anterior corneal haze may be the most important limiting factors in visual rehabilitation after DMEK. © 2014 by Elsevier Inc. All rights reserved.
Kraus R.,Universitatsklinikum Giessen und Marburg GmbH
Zeitschrift für Orthopädie und Unfallchirurgie | Year: 2012
Lawn mower injuries in children usually involve the lower extremities and can lead to serious amputation injuries. Treatment should look not only at the acute reconstruction, but also on maintaining the ability to grow. We report the case of a two-year-old boy with amputation of the heel. The boy was run over by a lawn mower. He suffered a complete loss of heel soft tissue, 30 % of the os calcis and the Achilles tendon. The one-stage reconstruction was performed by transplantation of an iliac crest graft, fascia lata to reconstruct the Achilles tendon and a microvascular latissimus dorsi flap. After one year, the functional and cosmetic result is excellent, the bone graft is healed completely and shows growth trends. The successful treatment of such a severe amputation injury requires the interdisciplinary cooperation between paediatric traumatologists, plastic surgeons, physical therapists and orthopaedic shoemaker. The result justifies the great effort. © Georg Thieme Verlag KG Stuttgart · New York.